Last month we introduced our readers to Santa Monica based and Celebrity OB/GYN, Dr. Sherry Ross. Like a girlfriend that we have known for years, she talked with us about how she got into her practice and the depth of her career, the difficulty that women have in talking about their vagina, the importance of knowing how to take care of this area - especially as it pertains to an athleisure lifestyle, her partnership with Summer's Eve, what she is up to this summer and more.

Dr. Ross shared so much information with us, we thought that we would spread out more of her knowledge in additional issues. If you missed last month, you can read it here and in thismonth's issue we are focusing on some of the common questions that she is asked by her patients and of course, she shares answers.

• What are some of the changes that occur with our vagina throughout the years.

The effect of aging on our body, including our vagina, is inevitable. Your vagina is as young and beautiful as you think it is in its appearance. Your personal attitude and vaginal confidence is the most important factor in how others perceive an aging vagina.

Just like any other part of your body with skin, glands and hair follicles, the appearance of the vagina is affected by the aging process and how well you care of it.

There are known offenders, such as childbirth and menopause, which leave battle scars that can be permanent, but there are things you can do to avoid needing a vaginal “face-lift’ also known as vaginal rejuvenation, in the future.

Hormonal changes over the decades also influence the integrity and elasticity of the vagina. First let’s be clear what we are talking about regarding the vagina. The “vagina” actually includes the lips, vulva or labia-minora and majora, the opening to the vagina and the clitoris.

Starting with puberty, the powerful effects of estrogen and progesterone, cause changes of the vagina including pubic hair, enlarging and more prominent labia or lips and more noticeable white vaginal discharge. As you age and lose your subcutaneous fat in your body, the fat in the vagina also decreases making the lips looks thinner.

Childbirth probably has the most dramatic effect on the vagina, especially if you have a vaginal delivery. A recent statistic showed that “30% of women who have a vaginal birth will have some form of trauma to the tissue and muscles in the vagina and pelvic floor. The vagina and all its elastic glory can only stretch so much during childbirth. With each vaginal delivery there is a little more stretching which has an accumulative effect that ultimately changes the outward appearance of the vagina. The pelvic floor muscles that stretch, distend and tear in the vagina to allow the baby’s head to come through this tight space will never be quite the same over time. The more vaginal deliveries you have, the more the vagina stretches, especially in the vaginal opening. Women often chose to have an elective cesaean section to avoid any trauma caused to the vagina from a vaginal birth.

There is a definite correlation between having a lot of vaginal deliveries and big babies that permanently stretch the outward appearance of the vagina.

With menopause and the loss of estrogen nourishing and hydrating the vagina, the tissue becomes dry, pale and dehydrated. The labia of the vagina can become fused and the vagina and clitoris shrink. The labia becomes less full, losing its fatty pads and the skin loses its collagen. The end result is lighter or darker appearing labia that sag. The medical term for this is vulva-vaginal atrophy.

• What are some of the reasons my vagina itches if I don’t have a yeast infection?

The itchy vagina can be challenging to figure out but is a common phenomenon. Once your health care provider has ruled out a yeast or bacterial infection it’s time to look other environmental causes including heavily fragranced body and laundry soaps, sanitary pads, sanitary wipes/pads, warming gels and scented lubricants, nylon underwear, diaphragms, condoms, saliva, semen and stress which are often the offending sources of the vaginal itch.

• What are reasons why my vagina smells funny?

The normal vagina tends to smell like “a vagina” which all of us women know what that means. When there is an unusual odor something is just not right down there. A classically smelling fishy vagina tends to be a bacterial infection such as Gardnerella. Other causes for a strange or offensive odor include a sexually transmitted disease such as Chlamydia, Trichomonas’s, Syphilis and Gonorrhea. Your diet, including garlic, onions, Brussels sprouts and red meat, can also create a different odor in the vagina. Smoking, alcohol and caffeine also affect the vagina’s smell and taste.

• What exactly is the importance of pubic hair?

The best kept secret about a women’s body is why we actually have pubic hair. No one really knows the answer to this question. The suspected theories, some medical and some not, include pubic hair prevents dirt and other floating germs to enter the vagina, it keeps our genitals warm, and it’s the perfect cushion during sex, bicycling and other forms of exercise that put pressure on our vagina.

Pubic hair is also thought to create ‘pheromones’ which are invisible sexual smells that are sexually enticing and erotic to your partner. We know pubic hair can be a decorative accessory under the sheets during Valentine’s Day or for different cultural preferences.

• What impact is the porn industry having on women and men when it comes to vaginas?

The truth is a lot of women don’t like their vaginas. 1 in 7 women have considered getting ”labiaplasty” which basically is trimming and tucking the lips of the vagina and tightening up the entrance. Many women admit that 1 in 5 compare themselves to those vaginas seen in porn. With porn on the rise, vaginas are everywhere. And yet, no one seems to want to admit how this new prevalence, and its resulting misconceptions about sex and the vagina is - or isn't - changing our romantic and sexual relationships and our relationships to our bodies and ourselves.

There’s no denying it. Porn is everywhere. Porn sites get more visitors each month then Netflix, Amazon, and Twitter combined. A recent statistic found that 70% of children ages 8 to 18 report having unintentionally stumbled across pornography online. The average age for a child to be exposed to pornography is now 11 years old. This means that our children are often “learning” about “normal” sexual behavior and physical appearance from the likes of Jenna Jameson and John Holmes. Many women (and men) now expect, even want, all vaginas to look like Jenna’s does. Girls and guys alike visit porn and other sexually graphic web sites, and not just for pleasure, but also to see what the perfect vagina and the ideal penis look like.

We as a society have to fight the porn epidemic and not allow our young women and men to think this is how they should be learning about sex and sexual relationships through porn. Awareness and education is vital!

• What are ways to keep my vagina young?

Your vagina is as young as you think it is. With that said, a young vagina is a healthy and confident vagina. Keeping the vagina clean and enjoying sexual pleasures keeps the vagina young regardless of age.

• Why do you think such little attention has been paid to women's sexual concerns compared with men's?

Unfortunately, there has been a history of “gender injustice” in the bedroom. Women have long been ignored when it comes to finding solutions to sexual dysfunction. If there were a scoreboard it would read 26 and O for men! In short, there are twenty-six approved medications for male erectile dysfunction and zero for women. Clearly, little attention has been paid to the sexual concerns of women, other than those concerns that involve procreation. Why is this the case? Why are women marginalized in every aspect of life? Sadly, this is a truth even in the medical space. Women are not getting the attention and respect they deserve.

Women simply want the same attention in sexual health and responsiveness from the medical community as men have had. With that in mind, the FDA is finally showing support for the challenges faced in female sexual health. Whether you choose a medical alternative, a little self-love in the afternoon, or a romantic weekend without electronics or distractions, the choice should be yours.

Just like any other part of your body with skin, glands and hair follicles, the appearance of the vagina is affected by the aging proce3ss and how well you care of it.

— Dr. Sherry Ross

• What are the main sexual problems/issues affecting women in their 20s and 30s?

Our sexuality is as part of our lives as is eating and sleeping. Sexuality is an important aspect of our wellbeing, and in a healthy romantic relationship it’s as important as love and affection. Enjoyable sex is learned. Sure, there’s instinct and maybe a dusting of magic involved, but you don’t magically have an orgasm without having an active role in making it happen. You and your partner have to acknowledge each other’s likes and dislikes, and learn how to satisfy each other. Open and honest conversations are necessary to make the sexual experience optimal for both of you, whether you have multiple partners or self-esteem to spare. For women, the sexual experience can be broken down into four parts: desire, arousal, vaginal lubrication, and orgasm. I know you’ve heard it before, but it can’t be overstated; your largest and most important sex organ is your mind. It’s what makes all the parts come together in what can (and should) be a sublimely satisfying experience.

Intimacy, sex and orgasm often all begin with desire. If you don’t have any desire you will not be able to have an orgasm-plain and simple, mission will not be accomplished. Understanding the cause of the sexual dysfunction is the most important step in optimizing a treatment plan. Relationship counseling, stress reduction, sex therapy or a weekend away with your partner without the kids may be all that’s needed to get you back on track.

Hypoactive sexual disorder, the most common female sexual dysfunction, is characterized by a complete absence of sexual desire. For the sixteen million women who suffer from this disorder, the factors involved may vary since sexual desire in women is much more complicated than it is for men. Unlike men, women’s sexual desire, excitement and energy tend to begin in that great organ above the shoulders, rather than the one below the waist. The daily stresses of work, money, children, relationships and diminished energy are common issues contributing to low libido in women. Other causes may be depression, anxiety, lack of privacy, medication side effects, medical conditions such as endometriosis or arthritis, menopausal symptoms such as a dry vagina, or a history of physical or sexual abuse. It’s not a myth after all that women are more complicated than men.

Learning how to have an orgasm is not a rite of passage. Orgasms are learned and you cannot expect any one to show you how to have one until you know your own sexual body mechanics.

In fact, 10-20% of women (of all ages) have never had an orgasm. Women typically have sexual and emotional issues that get in the way of intimacy which interrupt the four parts of a sexual experience for women.

For some women, finding and enjoying sexual intimacy and sex is difficult. 43% of women report some degree of difficulty and 12% attribute their sexual difficulties to personal distress.